As Smita pointed out very vividly, not only for Dali women but also for poor women across the subcontinent, there is no social or legal protection in fact. And furthermore, women's and girls' access to healthcare is extremely limited. Some of you may be aware of the history of family planning in the subcontinent, which in many instances unfortunately has been abusive of women's rights. And yet contraceptives are a fundamental tool that women need in order to control their bodies and their lives. While the rates vary within India (and certainly between India and Bangladesh and Nepal) the fact is that most poor women, especially in rural areas, still bear children…they deliver, they give birth at home, usually at best attended by a traditional birth attendant or family member who is entirely untrained even in normal delivery yet alone in situations of prolonged obstructed labor (which is very common in India due to the young age and physical immaturity of the mothers). Further, women have a large number of pregnancies and they may go through one or more abortions which are often unsafe even though abortion is legal in India. For those of you who have traveled at all in the subcontinent's rural areas you may have seen the consequences of the lack of care during pregnancy which are hugely damaging to the women's body and cause her to be outcast from her family and from society. A prolonged obstructed labor, which need not happen and which a simple cesarean section could take care of, often results in what are called fistular or holes in the bladder and in the intestines, such that she has no control over either urine or waste. It is a rather easily repaired damage, but again for those women who suffer this consequence there is no health service. Further more it is very common to have uterine prolapse in South Asia. And this is where literally the uterus falls outside of the woman's body. And it is not an uncommon phenomenon to see a woman (as I did) on the side of a road holding her uterus in her hands.
I mentioned that sexually transmitted diseases are dramatically increasing in India and that this is also increasing women's vulnerability to HIV-AIDS. And we have heard already about violence. There are no health services for women in India for either sexually transmitted diseases or violence. You will see on the rural roads in India and Bangladesh, not so much in Pakistan, signs painted on the sides of buildings advertising STD clinics or venereal disease clinics. These are virtually entirely for men; they are in the private sector; and generally they are run by quacks who do more harm than good. And as low as women's access to health services is, the utilization of services to women who do have access is very, very low as well-for reasons hinted at in Smita's presentation and in Sainath's photographs: desperate poverty, they do not have the cash and the ability to pay for services; social constraints including the burdens of caring for their children and husbands, or when they are younger, their siblings in the family; caste restrictions; and the fact that many women justifiably fear going to public health services because they are treated so badly, and because even hospitals have become places where you go to die not where you go to get well. So for all the reasons that I have described and more, across India rural girls and women face a dramatically increasing risk of HIV-AIDS. Unless national governments in the subcontinent and civil society as well as internationally agencies and donors act now, in unprecedented ways in South Asia, to right the wrongs against girls and women that we are discussing tonight we will see an unprecedented catastrophe. It will far, far outweigh the terrible catastrophe we are already witnessing in sub-Saharan Africa. So I cannot emphasize to you enough tonight how desperately important it is for all of us who are in a position to do so to encourage the development of basic health systems and basic healthcare across India, together with the empowerment of women and support to ensure their basic human rights.